#0990

Case Mix ADL Data Collection

A two-sided data collection form capturing the self-performance and staff assistance for bed mobility, transfers, eating, and toilet use using the same terminology as the RAI manual and providing space to document any variances on the back. Sold in pads of 100. HTT or HTH

#0994

Case Mix & MDS Behavioral Symptoms Data Collection

A data collection tool used to track the resident’s behavior during the assessment reference period.
Sold in pads of 100. HTH

#0116

Case Mix Supporting Documentation Cognitive/Communication/Mood/Health Conditions/Skin

A one-sided form providing supportive documentation during the assessment period covering the resident’s cognitive abilities, communication skills, mood indicators, health conditions, and skin assessment.
Sold in pads of 100.

#0001

Clinical Record Admission Audit

An audit tool used to verify that admission documentation is complete and placed on the clinical record.
Sold in pads of 100. HTT

$13.50

#0004

Clinical Record Discharge Audit

An audit tool used to verify that discharge documentation is complete and placed in the closed clinical record.
Sold in pads of 100. HTT

$13.50

#0211

Continuing Health Care Plan

A form used to document the resident’s care plan and updates as needed.
Sold in pads of 100. HTT

#0233

Discharge Summary for Anticipated Discharges (Recap, Final Status, Instructions)

A discharge form that combines the discharge summary and home discharge instructions all on one two-sided form. Sold in pads of 100. HTT

#0108

Immunization Record & TB Screening/Risk Assessment

Document the Mantoux, chest x-ray results, TB screening/risk assessment, flu, and pneumonia vaccine. Sold in pads of 100. HTT

#0135

MDS/Medicare Nursing Summary

A daily nursing summary for Medicare residents to document the status of the resident and provide supportive documentation. Sold in pads of 100. HTT

#0207

NCR (2pt) Resident Transfer

A two part carbonless form that allows staff to meet all required elements for transfer and provides check off boxes indicating additional documents sent. Sold in sets of 100.

$21.50 per set

#0219

NCR (2pt) Short Term Resident Referral

This two part carbonless form is used when sending the resident to the physician’s office, dialysis, or same day surgery. Sold in sets of 100.

#0132

Nurses’ Progress Notes

A two-sided nurses’ progress notes form. Sold in pads of 100. HTT

#0003

On-Going Clinical Record Audit

This audit tool is used to review the clinical records on an on-going basis during the resident’s stay to ensure that all forms are complete and maintained on the chart. Sold in pads of 100. HTT

$13.50

#0206

Post Discharge Instructions

A form used to provide home discharge instructions for the resident/care giver(s). This form is to be used in combination with the discharge summary record. Sold in pads of 100. HTT

#0604

Service Plan for Residential Care

A service plan used to evaluate the facility’s services provided to the residential resident on an on going basis. Sold in pads of 100. HTT

#0997

Summary Record

A two-sided nursing summary record that may be used as a weekly or monthly summary of the resident’s status. Sold in pads of 100. HTT

#0217

Summary Record and Care Plan Progress

A nursing summary record used weekly or monthly and includes documentation of progress toward care plan goals. Sold in pads of 100. HTH

#0212

Nursing Admission Assessment, 4 pages, stapled

A comprehensive admission nursing assessment for gathering pertinent information on all new residents. Sold in sets of 100. HTT